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RENAL UNIT CASE 5 |
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Clinical History: An 11 year old boy complained of a sore throat. This persisted for two days and he developed fever and nausea. A pediatrician did a throat culture and initiated penicillin therapy. The culture was subsequently reported to have grown Group A beta hemolytic streptococci. The child's symptoms gradually improved, but approximately two weeks later the fever, nausea and malaise returned. He appeared to be breathing rapidly, sometimes short of breath. The mother noted that the eyes were puffy and the ankles swollen. The urine was dark and cloudy. On examination the BP was 145/105 mmHg, pulse 120/min, respirations 35/min. The orbital and ankle edema were confirmed. Rales were heard bilaterally in the chest, but there were no heart murmurs. There was slight tenderness to percussion in the costovertebral angles. Chest X-ray showed evidence of congestion and edema in the lungs. The hematocrit was 37%, WBC 11,200/mm3. BUN was 48 mg/dl (normal < 20). Urinalysis: protein 2+ (24 hours excretion was 0.8 gm); specific gravity 1.012. Serum albumin 4.1 g/dl (normal 3.5 - 4.5). The urine sediment is shown in Figure 1. Questions: 1. What is the evidence that this patient has kidney disease? 2. What clinical pattern of kidney disease does this patient have? Can you explain the symptoms? 3. What morphological changes would you expect in the kidney? Is this what you see in Figure 2? 4. What studies could be done to determine the pathogenesis of this disease? Look at Figure 3 and Figure 4. What do they show? 5. Is a kidney biopsy needed in this case? 6. What is the prognosis? What are the possible short and long term complications of this disease? Is it necessary to hospitalize? 7. Are there other ways that this disease can present, clinically? 8. Compare this disease with acute rheumatic fever. 9. Summarize the characteristics of this disease according to clinical syndromes, morphology, pathogenesis and natural history. |
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